This mother’s life is in danger

この度は命あやふし母を焼く

迦具士ふたりわが胎に居る

There are two Fire Gods in my womb.

This mother’s life is in danger.

-       Yosano Akiko, 1912

There was an Opinion piece in the New York Times yesterday entitled, “Why Is It So Dangerous to Be Pregnant in America?” It notes that the U.S. has one of the highest maternal mortality rates among developed countries. The situation is even more severe when the data is parsed by race and state of residence. Women and their babies in southern states, women of color, and recent immigrants are at particularly high risk of death and complications. There are complex reasons for this, but it boils down to poor or insufficient health care, higher rates of smoking, alcohol or drug dependencies, poor nutrition, and racial bias on the part of health care workers. 

Meanwhile, Japan is among the safest places to have a baby, along with the familiar Nordic standouts that annoyingly outperform the rest of the world at just about everything. Certainly, racial and cultural homogeneity partly explains their better outcomes. However, that is not the whole story, because Ireland, Poland and Germany are also up toward the top with Japan and Norway, according to the New York Times. These countries have become steadily less ethnically homogenous in recent years and have their own issues with smoking and drugs. 

But there’s something that really surprised me as I researched Yosano Akiko’s experience as mother of 11 surviving children: not only is it safer now to have a baby in Japan, but it was safer in the first three decades of the 20th century, during Akiko’s childbearing years. I looked at a couple of articles in medical journals and found that the early 20th century was particularly dangerous in both the U.S. and industrially advanced parts of Europe. [1]  Simply put, this was because more and more women were going to hospitals to give birth. At the time, Western doctors in hospitals were experimenting with several new birthing procedures, including proactive use of forceps (shudder—the ‘shoehorn maneuver’), and anesthesia, particularly chloroform. No doubt these were well-intentioned experiments, but they led to many unnecessary deaths. In fact, Loudon’s study (referenced below) showed that in England in the 1930s, maternal and infant deaths were higher among well-to-do families than among the poor. Working class women in England in those days were still giving birth at home, with the help of midwives.

Like England’s working class, throughout the early 20th century, both rich and poor Japanese women were still giving birth at home with the help of midwives. Over time, specialized birthing centers emerged in Japan. Anesthesia was rarely used. Even today, most Japanese women do not use epidurals or morphine, and many birthing centers do not even offer it. In 2016, only around 5% of mothers received epidurals in Japan, compared to over 60% in the United States.[2]

For Akiko, of course, it is very sad that she lost two babies, one during childbirth and one at just a few days old. She wrote the tanka poem above when she was expecting twins (one of two sets). It was a harrowing experience and she very nearly died. However, it is also remarkable that she and eleven children did survive. Perhaps if she had been a wealthy Englishwoman, or even a 21st century American in the south, she would not have been so lucky.  

[1] “Maternal mortality in the past and its relevance to developing countries today”, Irvine Loudon, American Journal of Clinical Nutrition, 2000; Maternal and Child Health, jica.co.jp (https://www.jica.go.jp/jica-ri/IFIC_and_JBICI-Studies/english/publications/reports/study/topical/health/pdf/health_05.pdf)

[2] “Japan by the Numbers: Birth is too painful”, Eleanor Warnock, Tokyo Review, 18 Aug 2017.